"The difference is, because in my position, this time we're going to do it," he said.

"Your blood pressure's up, your cholesterol is up, you've got to do something, well, you know what it often takes? It takes that heart attack to bring people to their senses. Well, we're on the verge of a heart attack here."

Flemming says the plan won't harm patient care and he won't close hospitals.

He would not, however, rule out laying off more health care workers, saying it's hard not to eliminate jobs when rationalizing a $3 billion-system.About 74 per cent of health expenditures are directed to employee remuneration, he said.

In the past, health care was "hijacked by economic development," with decisions made to create jobs, not necessarily to provide the best care, Flemming said.

The range of health services must be appropriate, he said. They must also be effective, efficient and equitable.

"New Brunswickers understand the reality that our health-care system is at a crossroads and decisions need to be made," Flemming said in a statement.

"They told us very clearly that they don't want more money spent on health care. They want us to use the dollars they are providing more efficiently and more effectively. The new provincial health plan also supports this objective."

Short on details

Dr. Robert Desjardins, president of the New Brunswick Medical Society, contends the plan is short on specifics.

"It's in the details that the devil is, and the pain is, and we didn't hear that much, so no, I don't see anything new," said Desjardins, whose organization has been feuding with Flemming about medicare billings.

"How can you give the best possible services to your population, and keep the cheque book in balance? So, again a lot of rhetoric, a lot of philosophy, and nobody's against the principles that were put forward by the minister today, but the devil is in the details, and we didn't get that much. In fact, none."

Flemming says the 27-page plan, called Rebuilding Health Care Together - A Blueprint for Sustainability, is meant to be more of a vision statement and it will be up to the Horizon Health Network and Vitalité Health Network to work out the particulars.

The plan provides health professionals and system administrators with strategic guidance and direction for the planning, governance and delivery of health care in New Brunswick, said Flemming.

24 initiatives laid out for first year

It also includes a list of 24 initiatives that will be carried out during the first year to rebuild health, rebuild the system, or both, he said.

The list includes:

Completing a series of key steps "leading toward" the introduction of a drug plan for uninsured New Brunswickers "within the next year."

Launching a colon cancer screening pilot project.

Expanding the use of the Ottawa model to support smoking cessation.

Undertaking a series of initiatives to improve human resources management processes, such as staff scheduling, sick time management and employee wellness programs.

"I've not seen a minister of health in a long time with such a level of a firm commitment to what he delivers to the public," he said.

There will also be annual updates on whether the health plan hits benchmarks, said Flemming. But there are no empirical benchmarks or hard targets the public can use to measure whether it's working because the plan because it is a management philosophy approach, he said.

"If you were looking for, you know, how many New Brunswickers are going to have a family physician in 2013, and 2014, and 2015 and 2016, you're not going to get that."

Stephane Robichaud, the head of the New Brunswick Health Council, an arm's length government agency that acts as a watchdog, says the important measurement is whether people are getting healthier.

He believes the public understood that during consultations, when it was explained how expensive health care is.

"They thought they'd show up with a grocery list — we want more doctors, more nurses, more ERs, and so on. But once they were informed and provided with the context, that's not where they went," said Robichaud.

The planalso aims to get patients who are waiting for nursing home spaces out of hospitals by providing home-based care and special care services while they wait for a space to open in a nursing home.

"If we're paying $300,000 while someone is in the hospital, who shouldn't be there, surely we can spend some money to help these people not to go to a home, but to go to their homes," said Flemming.

Calls to end dualism

People's Alliance Leader Kris Austin says he has another idea the provincial government could use to cut health costs — reducing the number of regional health authorities.

He contends the province can't afford two and says he's not concerned about looking anti-bilingual.

"No, because anybody with common sense and reason would look at what we're saying, not what the Opposition is calling us, but what we are saying in policies and ideas. And what we're saying in health care is a very common sense approach, but neither the Liberals or Conservatives will touch it because they are scared to death," Austin said during a CBC political panel discussion.

"The reality is you take Vitalité, which is a predominantly francophone health authority, you take Horizon, which is a bilingual health authority, merge them, save tens of millions of dollars annually."

The health plan was developed based on thousands of comments received from the public during a consultation tour, as well as detailed submissions received from physicians, nurses, pharmacists and patients, he said.

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